Identification of the Ideal Reference Site and Pain Threshold Values for the Placement of Electric Pulp Testers in Permanent Upper and Lower Anterior Teeth: A Cross-Sectional Study.

INTRODUCTION: Electric pulp testers (EPTs) are widely used diagnostic tools for diagnosing traumatized teeth. Several factors can affect the result of an electric pulp test. One such factor that will affect the diagnosis is the electrode tip placement. Hence, the current study aims to identify the most painful site and response time threshold in healthy anterior teeth. METHODS: A total of 90 individuals, 48 male and 42 female, aged 19 to 25 years, were recruited. An EPT was placed on three different sites: the cervical, middle, and incisal third of the labial surface of both upper and lower anterior teeth (central incisor, lateral incisor, and canine) with an appropriate electrolyte as a conducting medium. Later, the threshold values were recorded, and pain assessment was done using the Memojis pain scale (MPS). Finally, the data was analyzed statistically using the Mann-Whitney U test. RESULTS: Mean and standard deviation values of reaction time were collected from 540 EPT readings (three sites from 180 teeth). Among the three sites tested, the difference between the upper and lower central incisors was statistically insignificant (p > 0.05). Similarly, when upper and lower lateral incisors and canines were compared, a statistically significant difference was observed among the three sites (p<0.05). There was a significant difference (p<0.05) in the pain scores only on the incisal and cervical thirds of the upper and lower central incisors. Only the incisal third showed a statistically significant difference (p<0.05) between the pain scores in the upper and lateral incisors. At the same time, a statistically significant difference in the pain scores was observed among the three tested sites between the upper and lower canines (p<0.05).  Conclusion: Lower threshold values were appreciated at the incisal third of all the upper and lower anterior teeth for placing the EPT. Most individuals have experienced a score of 2 (hurts little bit) for the perceived pain using EPTs for both the upper and lower anterior teeth.

A comparative evaluation of peppermint oil and lignocaine spray as topical anesthetic agents prior to local anesthesia in children: a randomized clinical trial.

Background: In pediatric dentistry, fear and anxiety are common among children. Local anesthetics (LA) are widely used to control pain and reduce discomfort in children during dental treatment. Topical anesthetics play a vital role in reducing pain and the unpleasant sensation of a needle puncture in children. Peppermint oil has been extensively used for various diseases. However, its anesthetic properties remain unknown. Peppermint oil, used in mouthwashes, toothpastes, and other topical preparations has analgesic, anesthetic, and antiseptic properties. This study aimed to compare and evaluate pain perception following the topical application of peppermint oil versus lignocaine spray before an intraoral injection in children, aged 8-13 years. Method: Fifty-two children, aged between 8-13 years, who required local anesthesia for dental treatment were divided into two groups of 26 each by simple random sampling (Group 1: 0.2% peppermint oil and Group 2: lignocaine spray). In both groups, physiological measurements (e.g., heart rate) were recorded using pulse oximetry before, during, and after the procedure. Objective pain measurement (Sound Eye Motor (SEM) scale) during administration and subjective measuremeant (Wong-Baker Faces Pain Rating Scale (WBFPRS)) after LA administration were recorded. This was followed by the required treatment of the child.Physiological parameters were compared between the two groups using an independent t-test for intergroup assessment and a paired t-test and repeated-measures ANOVA for intragroup comparisons. The Mann-Whitney U test was used to analyze the pain scores. Results: Intragroup mean heart rates, before, during, and after treatment were statistically significantly different (P < 0.05). However, the intergroup mean pulse rates did not differ significantly between the two groups. The mean WBFPS score in the lignocaine spray group was 4.133 ± 2.06 was statistically different from that of the peppermint oil group (0.933 ± 1.03; P < 0.001*). The mean SEM score was significantly lower in the peppermint oil group than that in the lignocaine spray group (P = 0.006). No negative effects were observed in this study. Conclusion: 0.2% peppermint oil was effective in reducing pain perception.

Visit to the Dentist for Oral Health Prevention at "Age One": A proposed policy report from the Indian perspective.

Early childhood caries is a major public health issue in India. The primary reason for poor oral health in children is a lack of awareness about the role of primary teeth and the importance of an early dental visit for infants and toddlers. The primary objectives of an early dental visit are to analyze the child's risk level, provide guidance to parents regarding proper oral hygiene measures, review dietary and eating habits, provide information regarding the infectivity of dental caries, review the risks of traumatic injuries and discuss factors which affect the development of occlusion. Through this paper, we are proposing an "Age One" policy that recognizes dentists, physicians, allied health professionals, community health-care workers, and nongovernmental organizations to work toward a child's overall health as partners to achieve this goal. The expectation is that this policy will provide guidance to childcare centers, pediatric dentists, other health-care professionals, and legislators regarding oral health activities and the promotion of oral health in infants. The purpose of the policy is to lay the foundation for a lifetime of preventive education and dental care, to help ensure optimal oral health beginning in childhood and continuing through the life course.

Genetic variations in exon 10 of ENAM and their association with early childhood caries.

OBJECTIVE: Enamelin is the largest enamel matrix protein encoded by the ENAM gene. The primary purpose of this study was to identify genetic variants in ENAM exon 10 that can alter susceptibility to early childhood caries (ECC). METHODS: This case-control study included 248 children aged 3-6 years, with 124 children diagnosed with ECC in the case group and 124 children without caries in the control group. Questionnaires were used to record demographic data, socioeconomic status, hygienic practices, and feeding practices, and a 24-hour diet diary was kept. Seven polymorphisms (rs7671281, rs1738668322, rs3796703, rs3796704, rs759376039, rs775159311, and rs1738678483) in ENAM exon 10 were sequenced. RESULTS: The heterozygous CT genotype of rs7671281 was significantly more common in the case group compared to the control group (odds ratio [OR], 6.1765; 95% confidence interval [CI], 2.05-18.58; P=0.0006). Under the dominant model, the TT genotype of rs7671281 was significantly more common in the control group (OR, 6.47; 95% CI, 2.15-19.39; P<0.001). The AG genotype of rs3796704 was significantly more common in the case group than in the control group (OR, 5.705; 95% CI, 1.60-20.25; P=0.006). Under the dominant model, the GG genotype of rs3796704 was significantly more common in children without caries than in children with caries (OR, 6.84; 95% CI, 1.96-23.90; P<0.001). CONCLUSIONS: The C allele of rs7671281 and the A allele of rs3796704 can increase susceptibility to ECC.

Association between passive smoking and dental caries status in children: A cross-sectional analytical study.

BACKGROUND: Several risk factors contribute to the development of dental caries in children, including sociodemographic, dietary, oral hygiene-related and other miscellaneous factors. Maternal smoking was highly associated with dental caries when compared to smoking by fathers or other household members. OBJECTIVES: The aim of the study was to determine the prevalence of dental caries and their association with exposure to environmental tobacco smoke (ETS) among 5- to 10-year-old students attending private and government schools. MATERIAL AND METHODS: A cross-sectional analytical study was conducted among schoolchildren. Data was collected from the primary caregivers using a pre-tested form to assess the ETS exposure under 5 domains based on history: antenatal exposure; exposure during the index period; exposure in the school neighborhood; exposure in restaurants/roadside stalls; and exposure in bus stops/railway stations. Dental caries was assessed based on the World Health Organization (WHO) guidelines from 1997. The association was reported using prevalence ratios (PRs) (95% confidence interval (CI)). RESULTS: Data was obtained from 211 schoolchildren attending government (39.8%) and private schools (60.2%). The overall prevalence (95% CI) of dental caries was 49.3% (42.5-56.1%). Among all the risk factors evaluated in the study, exposure to ETS was associated with a significantly increased risk of dental caries. The adjusted prevalence ratio (APR) of ETS exposure varied with the mother's educational status and high sugar exposure, although this was statistically insignificant. CONCLUSIONS: The prevalence of dental caries among schoolchildren aged 5 to 10 years in the city was moderate and similar to the national average. Among the risk factors assessed in the study, antenatal exposure to ETS was found to significantly increase the prevalence of dental caries by 41% after adjusting for other factors. Therefore, it is important to educate parents on the causal role of ETS exposure in dental caries.

Awareness of Child Abuse and Neglect: A Prospective Interventional Study among Schoolteachers from Andhra Pradesh.

AIM: To assess the awareness of schoolteachers from Andhra Pradesh towards child abuse and neglect (CAN) through pre- and post-educational intervention (audiovisual aid) questionnaires. MATERIALS AND METHODS: A cross-sectional study was conducted with 300 schoolteachers using a 12-item questionnaire that was created using the standard focus group discussion method. Baseline awareness of CAN was assessed using the questionnaire. Subsequently, all the schoolteachers were educated regarding the various types of CAN and the process of reporting CAN using an audiovisual aid. The same questionnaire was re-administered to all the teachers immediately after the intervention and after three months. The data were statistically analyzed using Fisher's exact test to compare the frequency and distribution of responses among the study participants at various intervals. RESULTS: A statistically significant difference (p value < 0.05) was observed in the awareness of the schoolteachers regarding CAN compared to the baseline and immediately after the intervention. However, there was no statistically significant difference (p value > 0.05) between immediately after the intervention and three months. CONCLUSION: There is a need to have awareness among schoolteachers concerning CAN. However, after education through audiovisual aids, teachers' awareness of CAN has been improved.

Comparative Evaluation of Antimicrobial and Smear Layer Removal Efficacy of Mangifera indica Kernel Extract as Root Canal Irrigant in Primary Molar: An In Vitro Study.

Background: Endodontic therapy aims to disinfect the entire root canal system. Extracts from the kernel of Mangifera indica has the potential to be a novel root canal irrigant that has yet to be studied. Hence, the present study evaluated the antimicrobial, and smear layer removal efficacy of the M. indica kernel extract as a root canal irrigant in primary molars. Materials and Methods: Methanolic extract of M. indica was prepared using the standard method. The antimicrobial efficacy of M. indica kernel extract was determined by agar diffusion method with 3% sodium hypochlorite and distilled water as controls, and the smear layer removal efficacy was assessed under the SEM after processing the root samples with different concentrations of M. indica kernel extract with 17% EDTA and distilled water as positive and negative controls, respectively. Results: A statistically significant antimicrobial efficacy was observed with the largest mean zone of inhibition recorded with 50 µl of M. indica kernel extract at 24 hr of incubation period, when compared to sodium hypochlorite as a root canal irrigant against Enterococcus faecalis using agar diffusion method at MIC value of 0.625 mg/ml. The smear layer removal efficacy of the M. indica kernel extract was not satisfactory, when compared with EDTA as a root canal irrigant in primary molars and observed under SEM. In contrast, a complete smear layer removal was observed with 17% EDTA solution. Conclusion: M. indica kernel extract has an enhanced antimicrobial efficacy but poor smear layer removal efficacy when used as a root canal irrigant.

Evaluation of the effectiveness of tell-show-do and ask-tell-ask in the management of dental fear and anxiety: a double-blinded randomized control trial.

Background: The objective of behavioral guidance is to establish effective communication that aligns with a child's requirements to manage disruptive behavior. This study aimed to evaluate the effectiveness of the Tell-Show-Do and Ask-Tell-Ask techniques in managing dental anxiety in children during their initial appointment. Methods: The study included 50 children (28 boys and 22 girls) without any prior experience between the ages of 7 and 11 at their first dental visit. The children were randomly categorized into two groups: Group 1, Tell Shows Do, and Group 2, Ask-Tell-Ask. Subsequently, all children underwent noninvasive treatment procedures such as restorations, sealants, and oral prophylaxis. Furthermore, behavioral management techniques were employed based on the allocated group. Finally, anxiety levels for all children were assessed using the Raghavendra, Madhuri, and Sujata Pictorial Scale (RMS-PS) and heart rate at three different intervals (before, during, and after). The obtained data were entered into Microsoft Excel, and statistical analysis was performed using SPSS software. A paired t-test and Mann-Whitney U-test were used to compare the mean and median values of the two groups and determine their effectiveness. Results: Children in the TSD group exhibited statistically significant heart rates and RMS-PS scores in intra-group comparisons. However, children in the ask-tell-ask group showed a significant reduction only in the RMS-PS scores (P < 0.001) but not in the measures used to assess heart rate (P < 0.001). Conclusion: Tell-Show-Do was more effective than ask-tell-ask in alleviating dental anxiety in children. The simultaneous application of these two strategies can synergistically alleviate dental anxiety during a child's initial dentist appointment.

Sucrose solution for alleviating needle pain during inferior alveolar nerve block in children aged 7-10 years: a randomized clinical trial.

Background: Intraoral local anesthesia is essential for delivering dental care; however, injection of this local anesthetic is perceived as the most painful and distressing agent for children, parents, and healthcare providers. Reducing pain as much as possible is essential to ensure smooth subsequent treatment procedures, especially in pediatric dentistry. In clinical practice, oral sucrose administration has been reported to decrease the pain during heel lance and cold pressor tests in neonates and children. This study aimed to determine whether the prior administration of a 30% sucrose solution reduced the pain related to inferior alveolar nerve block in children. Methods: A total of 42 healthy children aged 7-10 years requiring dental treatment of mandibular molars involving inferior alveolar nerve block were recruited. The participants' demographic details were recorded, height and weight were measured, and the anesthetic injection was delivered after receiving the respective intraoral sucrose solution and distilled water by the intervention (group 1) and control (group 2) group participants for 2 min. The subjective pain perceived during injection was measured using an animated emoji scale. The pain scores between the groups were compared using the Mann-Whitney U test. Results: The median pain score and range for the intervention and control groups were 4 (2 - 6) and 6 (4 - 8), respectively, and statistically significant differences (P < 0.001) were observed in the intervention group. Age, sex, height, and weight did not influence the analgesic effect of the sucrose solution. Conclusion: Oral administration of sucrose may relieve pain associated with inferior alveolar nerve block in children.

Influence of Temperament on the Acceptance of Two Conscious Sedation Techniques in Toddlers Undergoing Dental Treatment: A Randomised Cross Over Trial.

Background: Pediatric dentists often find it challenging to handle pediatric patients due to their fear, unease, and anxiety toward dental procedures. To address this, sedation agents such as intranasal midazolam and nitrous oxide are commonly used as pharmacological behavior management methods. A child's temperament affects their behavior in unfamiliar settings. Aim: To study the effect of child temperament on the acceptance of the nasal mask and intranasal drug administration in children undergoing dental treatment. Methods: Thirty-two anxious children aged three to five were randomly assigned to two groups. During the first visit, one group received intranasal midazolam sedation, while the other group received nitrous oxide administered through a mask. On the subsequent visit, the groups crossed over. The parent assessed the child's temperament, and the acceptance of the sedation methods was recorded. The Ohio State University Behavioral Rating Scale (OSUBRS) was employed to assess behavior during the administration of local anesthesia. Statistical analysis was carried out using the chi-square test and Mann-Whitney U test (p value <0.05). Results: Children exhibited greater acceptance of the nasal mask compared to using the intranasal route for delivering midazolam during the induction process. A significant statistical influence of temperament was observed on the acceptance of the nasal mask and the intranasal atomisation device (p value <0.05). The mean OSUBRS scores did not show any statistically significant differences between the sedation groups (p = 0.14). Conclusion: Most children demonstrated a more favorable acceptance of the nasal mask during the induction process; however, intranasal midazolam can serve as an effective alternative for anxious patients who struggle to keep the nitrous oxide mask on during the dental procedure. The adoption of these methods is influenced directly by the child's temperament.

Single nucleotide polymorphisms of enamel formation genes and early childhood caries - systematic review, gene-based, gene cluster and meta-analysis.

Introduction: Genetic polymorphisms of genes regulating amelogenesis can alter susceptibility to Early Childhood Caries (ECC). This systematic review aims to analyze associations between single-nucleotide polymorphisms of enamel formation genes and ECC. Methods: Search was conducted across PUBMED, CINAHL, LILACS, SCOPUS, EMBASE, Web of Science, Genome-Wide Association Studies databases from January 2003 to September 2022. This was supplemented by hand search. Totally 7124 articles were identified and 21 articles that satisfied the inclusion criteria proceeded to data extraction. Quality assessment was done using the Q-Genie tool. Results: Quantitative synthesis revealed that homozygous genotype AA of rs12640848 was significantly higher in children with ECC with an odds ratio of 2.36. Gene-based analysis revealed significant association between six variants of AMBN, four variants of KLK4, two variants of MMP20, and a single variant of each of MMP9 and MMP13 genes and ECC. The Bonferroni corrected-log10 P value of amelogenesis gene Cluster was 2.25 (0.05/88 = 5.6 × 10-4). Search Tool for Retrieval of Interacting Genes and Proteins plot constructed to comprehend the protein-protein interaction revealed the presence of four functional clusters. Gene function prediction using Multiple Association Network Integration Algorithm revealed that physical interaction between these genes was 69.3%. Conclusion: Polymorphisms of genes regulating amelogenesis can influence the susceptibility to ECC. AA genotype of rs12640848 may increase the susceptibility to ECC. Gene-based analysis revealed a significant association between multiple polymorphisms of genes regulating amelogenesis and ECC.

Comparative evaluation of "Tell-Tell-Tell," "Ask-Tell-Ask," and "Teach back" communication techniques on oral health education among 12-13-year-old children - An educational intervention trial.

Background: Effective communication with children can improve their understanding and aid in complying with oral hygiene instructions. Aim: The aim is to compare the retentiveness of oral hygiene instructions in children educated using three communication techniques. Methodology: One hundred and twenty children in the age range of 12-13 years were included in the study. Baseline awareness of oral hygiene maintenance was assessed using a questionnaire. Twenty children were randomly assigned to each group: Tell-Tell-Tell, Ask-Tell-Ask, Teach-back, and information provided. Knowledge was reassessed after a week; data were tabulated and assessed statistically. Results: There were no statistically significant differences in the baseline data among the groups (P > 0.05). Regardless of the group, there was an improvement in knowledge regarding the frequency and timing of brushing as well as the cause of dental caries after the intervention. However, children in Ask-Tell-Ask and Teach back showed significant improvement over Tell-Tell-Tell (P ≤ 0.01). Conclusion: Communication strategies, such as Ask-Tell-Ask and Teach back, which have a strategy to involve children, have been shown to be superior over Tell-Tell-Tell.

Erratum: Addendum: Comparative evaluation of efficacy of external vibrating device and counterstimulation on child's dental anxiety and pain perception during local anesthetic administration: a clinical trial.

[This corrects the article on p. 345 in vol. 21, PMID: 34395902.].

Erratum: Addendum: Comparative evaluation of efficacy of Physics Forceps versus conventional forceps in pediatric dental extractions: a prospective randomized study.

[This corrects the article on p. 547 in vol. 21, PMID: 34909472.].

Memojis Pain Scale: A novel pain assessment tool.

BACKGROUND: Dental pain exerts a considerable impact on the psychosocial well-being of children; reliable management of pain depends on the ability to assess pain intensity. AIM: To validate and compare a new memojis pain assessment scale with the Faces Pain Scale-Revised (FPS-R) and Wong-Baker FACES Pain Rating Scale (WBFPS) in assessing dental pain experienced by children. DESIGN: Two hundred and fifty healthy children aged 5-9 years without any past dental experience and requiring local anaesthesia (LA) administration were recruited. Three different scales [FPS-R, WBFPS and Memojis Pain Scale (MPS)] were applied to assess the children's pain during LA administration. The preferences of each child based on the ease of understanding the faces were recorded. RESULTS: Pearson correlation test was performed to determine the correlation between MPS with WBFPS and MPS with FPS-R. A strong correlation was seen when comparing MPS with WBFPS (r = .966; p < .001) and MPS with FPS-R (r = .969; p < .001), and 81.6% of the children preferred MPS. CONCLUSION: The Memojis Pain Scale was an effective pain assessment tool. It can be employed as an alternative scale for pain assessment in children.

Arginine: A New Paradigm in Preventive Oral Care.

Dental caries is ubiquitous and one of the most prevalent oral diseases and the foremost cause of dental pain and poor quality of life (QoL). Fluoride is an effective caries preventive agent; however, despite its use, there remain some gaps in prevention of dental caries. Arginine, an amino acid, helps to maintain a noncariogenic plaque. It shows synergistic effects with fluoride in dental caries and can help nourish the tooth by enhancing the remineralization effect of fluoride. Supplementing fluoride dentifrices with arginine can bridge the gap in caries prevention. Several clinical studies with 1.5% arginine + fluoride provide evidence for its use in prevention of dental caries. This report throws light on the benefits of arginine in dental caries and guides on its use with fluoride. Recommendations given in the report will help in effective prevention of dental caries. How to cite this article: Goyal V, Damle S, Puranik MP, et al. Arginine: A New Paradigm in Preventive Oral Care. Int J Clin Pediatr Dent 2023;16(5):698-706.